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How Effective In EEG In Diagnosing Seizure Disorder?

Posted on Mon, 18 May 2015

Question: Hi my name is XXXX I'm 39 and have been recovering from viral labrinthitis for the past three months. I was sent to a neurologist who was extreemly rude and i always got circular logic and the run around with non concise answers. I've had 8 mri of the body all normal,blood work low b12 and two 3 day video eeg ,one of which was inpatient. I have been told they found evidence of a seziure disorder, partial and was put on keppra. I almost ended my life on that drug and had i guess a psychotic break. I'm usually jovial and pleasent. ..... on to my question I have never had a seziure that i know of and am afraid to be on another anti seziure medication understanably so. My pcp put me on clonopin at my behest because i was on it for anxiety years ago and I've read it can be effective for partial seziures. My neurologist also said if i ever have a glass of wine again i will die. Is she correct can i never drink again. I'm not a heavy drinker but sure would miss my 3 glasses on fridays. I'm confused by all of this can you help. I have been housebound for almost 4 months and am slowly unraveling. Thank you also could seziure activity be the result of the virus running it's course

Answered by Dr. Shubham Mehta (14 hours later)

Brief Answer:
EEG is not diagnostic for seizure disorder

Detailed Answer:
Hello
Welcome to HCM.
I can understand your concerns.

EEG is not the diagnostic modality of choice. It is not sensitive to diagnose a seizure disorder.
The best way to diagnose a seizure disorder is by clinical history.

Since you have not had seizure at any time in past, I think eeg findings should not be the basis for starting anti-epileptic treatment.

Yes, klonopin is effective in seizures and is a good anti-anxiety drug. But it does have habit forming potential.

Single glass of wine does not kill anybody, unles there some pre-existing medical disorders like liver failure.
He might have said this because he would have wanted you to stay abstinent. May be for your good...

I donot think viral labrynthitis could lead to seizures.

To sum up, i would opine that;
You can take klonopin for anxiety as per requirement and as directed by physician.
Continue with whatever treatment you are taking for labrynthitis.
Do not worry about seizures.

Hope this helps to clear your confusion.

I wish you well.
Take care.
Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shubham Mehta (4 hours later)

the neurologist is also an epitiliologist and she said i will die or go into status epileptis if i do not take the Lamictal. she has spent a great deal of time inducing fear based methods to get me to take medication. we found the disorder by happenstance and i ,in my own oppinion, believe her relegious ideals block her medical judgement. she has mentioned her faith openly with many displays and words. i was a heavy drinker in my 20s but only fridays now and usually around three. how long can i expect to feel fatigued from this virus. She says I'm fatigued due to the seziures going on. i have had severe brain fog but it's better off keppra. how long do most viral labrenthitis or viral neuritis since no one can tell the difference last. i feel like I'm recouping and have begun an excersise regiment to help with energy. my b12 was under 1000 units but no other abnormal blood work cbc,cmp,tsh,ana,and others all WNL. why is an eeg not a good tool to use. she says its the very best. at first she also said i had hyperflexaxion and clonus but then took all that back saying some people just have hyperreflexes. thanks for your time it is much appreciated!

Answered by Dr. Shubham Mehta (13 hours later)

Brief Answer:
EEG has high false positives and false negatives.

Detailed Answer:
Dear XXXXXXX

Sorry for the late response.

EEG is not a good tool in diagnosing epilepsy because there are high chances both false positive and false negative results.

Viral labrynthitis usually take 6-8 weeks to remit. But in some cases, this may take months. To my knowledge, I do not think this can be a cause of seizures. Yes, it can cause weakness. Take plenty of water and multivitamin supplements for weakness.

Even if there are evidences of seizure on EEG, clonazepam should be adequate.
In my opinion, no one can predict when a patient will land into status epilepticus.

Hyperreflexia is common in anxiety states as well.

I do not understand why your neurologist has been rude and uncaring for you, why she has been forcing you to take medicines.

I hope my suggestions make some sense for you.

I wish you well.
Thanks.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar